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Bible School
- Overview
- Apply
- First Year
- Second Year
- Dates & Fees
- Visit
- Media
- Photos
- FAQs
Camp
- Overview
- Register / Login
- Elementary
- Junior High
- High School
- Day Camp
- Activities
- Counselors
- Photos
- Volunteer
- Camp Checklist
- FAQs
Retreats
Podcast
About
Give

Summer Staff Volunteer Application

2025 Summer Volunteer Medical Form

All applicants must fill this out before volunteering with us.

1Personal Information

2Insurance

3Health History

4Activity & Treatment Authorization

Name*
First Middle Last
Birthday*
MM slash DD slash YYYY
Age*
Sex*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone:*
Father's Name*
First Last
Father's Phone Number:*
Mother's Name*
First Last
Mother's Phone Number:*
Emergency Contact Name*

If parent cannot be reached
Emergency Contact Phone:*

Insurance Carrier
His Hill provides insurance as secondary coverage
Carrier Name*
Group Number
Member I.D.
Carrier Address*
Insurance Phone Number*

Health History
Check yes or no if you ever had in the past or are presently being treated for any of the following conditions:
Asthma*
- Yes
- No
Ear/Throat Infections*
- Yes
- No
Heart Trouble*
- Yes
- No
Seizures*
- Yes
- No
Diabetes*
- Yes
- No
Chicken Pox*
- Yes
- No
GI Disturbance*
- Yes
- No
Thyroid*
- Yes
- No
Mumps*
- Yes
- No
Measles*
- Yes
- No
Migraines*
- Yes
- No
Kidney Disease*
- Yes
- No
Anxiety*
- Yes
- No
Depression*
- Yes
- No
Psychiatric Treatment*
- Yes
- No
Bleeding/Clotting Disorders*
- Yes
- No
Ulcers*
- Yes
- No
Rheumatic Fever*
- Yes
- No
Operations*
- Yes
- No
Bulimia*
- Yes
- No
Binging/Purging*
- Yes
- No
Anorexia*
- Yes
- No
Allergies*
- Yes
- No
Hypoglycemia*
- Yes
- No
Serious Injuries*
- Yes
- No
Wears Contacts*
- Yes
- No
Food allergies?*
- Yes
- No
Please explain any "yes" responses, including dates
Immunization
Date of most recent Tetanus booster shot
List any medications you are currently taking
List any dietary or physical/other restrictions
Are you currently under treatment for a medical condition whatsoever?*
- Yes
- No
If so, please specify:
Please select here if you've chosen NOT to immunize

Activity and Treatment Authorization
This health history is correct so far as I know, and give my consent to engage in all school/camp/athletic activities, except as noted by me and my physician. I hereby give permission to the staff at His Hill to secure and administer medical treatment, as they deem appropriate, including hospitalization. I also give my permission to the medical personnel selected by His Hill to order x-rays, routine tests and treatments. If hospitalized, I give permission for the His Hill staff to act on my behalf, and represent my family in their absence.
Name*
First Last
I authorize with my electronic signature for His Hill Ranch Camp. (Signed by student/summer volunteer above 18 years old. Parent/guardian signed if applicant is under 18 years old)
Date*
MM slash DD slash YYYY

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His Hill is a member of Torchbearers International

Mailing

PO Box 9
Comfort, TX 78013

Location

102 Mill Dam Rd
Comfort, TX 78013

Contact

830.995.3388
Email

© 2025 His Hill. All Rights Reserved.